Analysis of the equity of emergency medical services: a cross-sectional survey in Chongqing city.
Abstract
BACKGROUND: Due to reform of the economic system and the even distribution of available
wealth, emergency medical services (EMS) experienced greater risks in equity. This
study aimed to assess the equity of EMS needs, utilisation, and distribution of related
resources, and to provide evidence for policy-makers to improve such services in Chongqing
city, China. METHODS: Five emergency needs variables (mortality rate of maternal,
neonatal, cerebrovascular, cardiovascular, injury and poisoning) from the death surveillance,
and two utilisation variables (emergency room visits and rate of utilisation) were
collected from Chongqing Health Statistical Year Book 2008 to 2012. We used a concentration
index (CI) to assess equality in the distribution of needs and utilisation among three
areas with different per-head gross domestic product (GDP). In each area, we randomly
chose two districts as sample areas and selected all the medical institutions with
emergency services as subjects. We used the Gini coefficient (G) to measure equity
in population and geographic distribution of facilities and human resources related
EMS. RESULTS: Maternal-caused (CI: range -0.213 to -0.096) and neonatal-caused (CI:
range -0.161 to -0.046)deaths declined in 2008-12, which focusing mainly on the less
developed area. The maternal deaths were less equitably distributed than neonatal,
and the gaps between areas gradually become more noticeable. For cerebrovascular (CI:
range 0.106 to 0.455), cardiovascular (CI: range 0.101 to 0.329), injury and poisoning
(CI: range 0.001 to 0.301) deaths, we documented a steady improvement of mortality;
the overall equity of these mortalities was lower than those of maternal and neonatal
mortalities, but distinct decreases were seen over time. The patients in developed
area were more likely to use EMS (CI: range 0.296 to 0.423) than those in less developed
area, and the CI increased over the 5-year period, suggesting that gaps in equity
were increasing. The population distribution of facilities, physicians and nurses
(G: range 0.2 to 0.3) was relatively equitable; the geographic distribution (G: range
0.4 to 0.5) showed a big gap between areas. CONCLUSIONS: In Chongqing city, equity
of needs, utilization, and resources allocation of EMS is low, and the provision of
such services has not met the needs of patients. To narrow the gap of equity, improvement
in the capability of EMS to decrease cerebrovascular, cardiovascular, injury and poisoning
cases, should be regarded as a top priority. In poor areas, allocation of facilities
and human resources needs to be improved, and the economy should also be enhanced.
Type
Journal articleSubject
ChinaCross-Sectional Studies
Emergency Medical Services
Female
Health Equity
Health Services Accessibility
Humans
Infant
Infant Mortality
Male
Maternal Health Services
Maternal Mortality
Pregnancy
Socioeconomic Factors
Surveys and Questionnaires
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https://hdl.handle.net/10161/15798Published Version (Please cite this version)
10.1186/s12939-015-0282-8Publication Info
Liu, Yalan; Jiang, Yi; Tang, Shenglan; Qiu, Jingfu; Zhong, Xiaoni; & Wang, Yang (2015). Analysis of the equity of emergency medical services: a cross-sectional survey in
Chongqing city. Int J Equity Health, 14. pp. 150. 10.1186/s12939-015-0282-8. Retrieved from https://hdl.handle.net/10161/15798.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Shenglan Tang
Mary D.B.T. and James H. Semans International Distinguished Professor
Areas of Expertise: Health Services Research, Health Policy, Disease Control Strategy,
and Implementation Science

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